Basic Information
| Provider Information | |||||||||
| NPI: | 1720181647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORSTER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5251 VIEWRIDGE CT | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582666553 | ||||||||
| FaxNumber: | 8582666593 | ||||||||
| Practice Location | |||||||||
| Address1: | 754 MEDICAL CENTER CT | ||||||||
| Address2: | STE. #204 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919116654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196162100 | ||||||||
| FaxNumber: | 6196162104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA17441 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.